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Modeling repeated labor curves in consecutive pregnancies: Individualized prediction of labor progression from previous pregnancy data.

ABSTRACT: The measurement of cervical dilation of a pregnant woman is used to monitor the progression of labor until 10 cm when pushing begins. There is anecdotal evidence that labor tracks across repeated pregnancies; moreover, no statistical methodology has been developed to address this important issue, which can help obstetricians make more informed clinical decisions about an individual woman's progression. Motivated by the NICHD Consecutive Pregnancies Study (CPS), we propose new methodology for analyzing labor curves across consecutive pregnancies. Our focus is both on studying the correlation between repeated labor curves on the same woman and on using the cervical dilation data from prior pregnancies to predict subsequent labor curves. We propose a hierarchical random effects model with a random change point that characterizes repeated labor curves within and between women to address these issues. We employ Bayesian methodology for parameter estimation and prediction. Model diagnostics to examine the appropriateness of the hierarchical random effects structure for characterizing the dependence structure across consecutive pregnancies are also proposed. The methodology was used in analyzing the CPS data and in developing a predictor for labor progression that can be used in clinical practice.

SUBMITTER: Buhule OD

PROVIDER: S-EPMC7171572 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Modeling repeated labor curves in consecutive pregnancies: Individualized prediction of labor progression from previous pregnancy data.

Buhule Olive D OD Choo-Wosoba Hyoyoung H Albert Paul S PS

Statistics in medicine 20200114 8

The measurement of cervical dilation of a pregnant woman is used to monitor the progression of labor until 10 cm when pushing begins. There is anecdotal evidence that labor tracks across repeated pregnancies; moreover, no statistical methodology has been developed to address this important issue, which can help obstetricians make more informed clinical decisions about an individual woman's progression. Motivated by the NICHD Consecutive Pregnancies Study (CPS), we propose new methodology for ana ...[more]

PMID: 31943255

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Project description:The potential toxicity of background exposure to perfluoroalkyl substances (PFASs) is currently under active investigation. Such investigations typically rely on a single measure of PFAS concentration, yet the longer-term reliability of a single measure has not been well characterized, especially among reproductive-aged women. Our aim was to investigate the association between PFAS plasma concentrations of 100 women in two consecutive pregnancies and explore changes in plasma concentration related to reproductive factors. The women in our study were enrolled in the Norwegian Mother and Child Cohort Study (MoBa) from 2003 to 2009. About half of them breastfed exclusively for 6 months and the rest of the participants did not breastfeed between the two consecutive pregnancies (median time between pregnancies: 18 months). Maternal blood was collected at mid-pregnancy and plasma was analyzed for 10 PFASs. Statistical analyses were restricted to 6 PFASs that were quantifiable in more than 80% of the samples. We estimated the correlation between repeated PFAS measurements, the percentage change between pregnancies and the effect of several reproductive factors in multivariate linear regression models of PFAS concentrations in the second pregnancy. The Pearson correlation coefficient between repeated PFAS measurements was, for perfluorooctane sulfonate (PFOS), 0.80; perfluorooctanoate (PFOA), 0.50; perfluorohexane sulfonate (PFHxS), 0.74; perfluorononanoate (PFNA), 0.39; perfluoroundecanoate (PFUnDA), 0.71; and perfluorodecanoate (PFDA), 0.60. Adjustment for maternal age, delivery year, and time and breastfeeding between pregnancies did not substantially affect the observed correlations. We found 44-47% median reductions in the concentrations of PFOS, PFOA and PFHxS between pregnancies, while the change in concentrations between pregnancies was smaller and more variable for PFNA, PFUnDA and PFDA. The variation in plasma concentrations in the second pregnancy was mainly accounted for by the concentration in the first pregnancy; for PFOS, PFOA, and PFNA, breastfeeding also accounted for a substantial proportion. In conclusion, we found the reliability of PFAS measurements in maternal plasma to be moderate to high, and in these data, several factors, especially breastfeeding, were related to plasma concentrations.

Dataset Information

Modeling repeated labor curves in consecutive pregnancies: Individualized prediction of labor progression from previous pregnancy data.

Publications

Modeling repeated labor curves in consecutive pregnancies: Individualized prediction of labor progression from previous pregnancy data.

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